Ulinastatin for acute lung injury and acute respiratory distress syndrome:A systematic review and meta-analysis

摘要

AIM:To investigate the efficacy and safety of ulinastatin for patients with acute lung injury(ALI)and those with acute respiratory distress syndrome(ARDS).METHODS:A systematic review of randomized controlled trials(RCTs)of ulinastatin for ALI/ARDS was conducted.Oxygenation index,mortality rate[intensive care unit(ICU)mortality rate,28-d mortality rate]and length of ICU stay were compared between ulinastatin group and conventional therapy group.Meta-analysis was performed by using Rev Man 5.1.RESULTS:Twenty-nine RCTs with 1726 participants were totally included,the basic conditions of which were similar.No studies discussed adverse effect.Oxygenation index was reported in twenty-six studies(1552 patients).Ulinastatin had a significant effect in improving oxygenation[standard mean difference(SMD)=1.85,95%CI:1.42-2.29,P<0.00001,I 2=92%].ICU mortality and 28-d mortality were respectively reported in eighteen studies(987 patients)and three studies(196 patients).We found that ulinastatin significantly decreased the ICU mortality[I 2=0%,RR=0.48,95%CI:0.38-0.59,number needed to treat(NNT)=5.06,P<0.00001],while the 28-d mortality was not significantly affected(I 2=0%,RR=0.78,95%CI:0.51-1.19,NNT=12.66,P=0.24).The length of ICU stay(six studies,364 patients)in the ulinastatin group was significantly lower than that in the control group(SMD=-0.97,95%CI:-1.20--0.75,P<0.00001,I 2=86%).